Peritoneal Dialysis III: Nursing Management

Nurses must monitor vital signs, daily weight, fluid balance, and laboratory values including potassium, blood urea nitrogen (BUN), and creatinine. Regular assessment of serum electrolytes helps prevent imbalances that could cause cardiac or neuromuscular complications. These measurements guide adjustments to dialysate concentration and overall patient management.

Peritonitis signs include abdominal pain, cloudy effluent, fever, and abdominal tenderness or rebound tenderness. Nurses must remain vigilant in detecting these infection indicators and promptly report them to the healthcare provider. Early identification and treatment of peritonitis are critical to prevent severe complications and ensure patient safety.

Nurses assess for fluid overload by monitoring for edema, dyspnea, and elevated blood pressure, while dehydration presents as hypotension, dry mucous membranes, and poor skin turgor. Close monitoring of fluid intake and output, combined with regular vital sign assessment, helps identify imbalances. Adjustments to dialysate concentration may be necessary to manage the patient's fluid and electrolyte needs effectively.

Nurses must educate patients on maintaining aseptic technique during catheter care and exchanges, emphasizing hand hygiene and sterile supply use. Regular inspection of the catheter exit site for redness, discharge, or swelling is essential. Patients should be instructed to report cloudy effluent or fever immediately, as these may indicate peritonitis or exit site infection requiring prompt healthcare provider notification.

Nurses should instruct patients to limit physical activities during dwell time, particularly avoiding weight lifting and jumping, which increase intra-abdominal pressure. Walking is encouraged as it does not significantly increase intra-abdominal pressure. Patients should drain PD fluid before exercising to minimize complications and maintain optimal dialysis function.

Nurses collaborate with dietitians to ensure adequate protein intake, as protein loss occurs during dialysis. Patients may need to limit sodium, potassium, and phosphorus intake to prevent imbalances. Regular assessment of nutritional status, including serum albumin levels and weight trends, helps prevent malnutrition and supports overall health outcomes.

Patients may experience anxiety or frustration related to dialysis and body image concerns. Nurses should provide opportunities for patients to express concerns and recommend support groups or counseling. Helping patients feel confident managing peritoneal dialysis independently at home improves adherence, reduces complications, and enhances overall quality of life and outcomes.